Health Plans

Streamlined Success

Achieve compliance and strategic network management objectives and outcomes with a streamlined, comprehensive approach to provider data management.

PROVEN, CONFIGURABLE SOLUTIONS

Your members deserve access to quality providers within your health plans. Streamline network administration with Verisys’ configurable credentialing platform powered by quality provider data to increase revenue by accelerating enrollment and lower operational costs by reducing false claims.

See how health plans use Verisys to credential and enroll providers to ensure quality care with optimal outcomes.

  • Provider Directory meets compliance and consumer demands for easy-to-use online, mobile, and printed formats.
  • Screen and monitor providers for exclusions and sanctions with Verisys’ gold standard database FACIS – Fraud Abuse Control Information System.
  • Data Services improves data accuracy, timeliness, and quality by eliminating inaccurate and incomplete provider data.
  • Credential and enroll providers with CheckMedic, Verisys’ comprehensive credentialing SaaS platform that provides user-friendly dashboards for turnkey provider data management. A unique secure digital profile, a MedPass is created for each individual and entity.
  • Streamline and consolidate siloed administrative duties with Verisys’ Network Management solution that strengthens your provider relationship management with a custom Salesforce app.
  • Instantly verify prescriber credentials with ProviderCheck, Verisys’ real-time transaction engine that issues a pass/fail on five key data points.
  • Verify a provider’s history and status of all licenses held nationwide with Verified License Search and Status, VLSS.

There’s a lot under the Verisys hood

High standards:

Verisys is the only Credentials Verification Organization (CVO) that is National Committee for Quality Assurance (NCQA) certified for 11 out of 11 verification services, is Utilization Review Accreditation Commission (URAC) accredited, and is ISO 9001:2015 (quality management), ISO 27001:2013 (information security), and AICPA SOC 2 (customer data security) certified.

Data platform:

Verisys’ comprehensive data platform contains more than 320 million aggregated records derived from thousands of primary sources — and growing. Data collection began in 1992 with its Fraud Abuse Control Information System (FACIS). Verisys stores cumulative records that provide a unique, longitudinal view of exclusions, debarments, sanctions, and disciplinary actions.

Data matching science:

Verisys developed a proprietary matching logic using algorithms in combination with oversight by data analysts to collect, transform, and match each piece of data to the right provider/entity consistently with 99.9% accuracy. We stand behind our results 100% of the time.

Technology:

Our innovative technology stack transforms millions of records into intuitive, interoperable formats. This powerful solution simplifies workflow for turnkey compliance and a better bottom line.

Software:

Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic 20 years ago. Solutions innovation continued with real-time search and transaction engines, VerisysConnect, and ProviderCheck that instantly deliver accurate provider data when you need it. These unique, comprehensive solutions streamline provider data management, credentialing, privileging, and enrollment.

From the Verisys Blog

Simplify Your Medical Credentialing Process With a Credentialing Software Solution

Simplify Your Medical Credentialing Process With a Credentialing Software Solution

For many healthcare organizations, it’s difficult to keep up with medical credentialing – after all, you are in the business of healing, not chasing after provider data. Whether you use paper, spreadsheets, email, or fax, the credentialing process can be long and frustrating when you’re doing it internally. What’s the solution? Medical credentialing software. It saves time, reduces administrative burden, improves accuracy, and helps maintain compliance. The Medical Credentialing and Privileging Processes It’s important for a practitioner to be credentialed and have privileges granted before beginning to practice medicine and bill for...

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What Is Provider Enrollment?

What Is Provider Enrollment?

By Tracey Tokheim, Senior Director of Product Management at Verisys Corporation Many healthcare providers justifiably experience confusion over the terminology surrounding provider enrollment, which is only getting more complicated with the ongoing changes in healthcare. A common confusion is the difference between provider enrollment and provider credentialing. Provider enrollment is the application process by which a practitioner is approved to seek reimbursement from government and/or third-party payers or seek admitting privileges at a hospital. Provider credentialing is a separate process of obtaining, verifying, and assessing the...

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What is the Difference Between Payer Enrollment and Credentialing?

What is the Difference Between Payer Enrollment and Credentialing?

Among healthcare practitioners, there is sometimes confusion between the concepts of “payer enrollment” and “medical credentialing.” The process of payer enrollment and credentials verification is intricate, and it becomes more so with each passing year. It’s important for your business to understand the difference and find a way to navigate the intricacies. Find a CVO Partner First off, your organization should consider finding a partner in this process. Without the proper verification services, small practitioners – and large ones too – lose money drowning in paperwork. This is where outsourcing to a Credentials Verification Organization...

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Better, Simpler, Faster: Managing Your Provider Enrollment and Credentialing Data

Better, Simpler, Faster: Managing Your Provider Enrollment and Credentialing Data

When it comes to provider data, Tracey Tokheim, senior director of product management and enrollment at Verisys, understands the frustrations in keeping provider data accurate in the many places that organizations have it. Tokheim has worked in credentialing, enrollment, contracting, and billing for 32 years. She has observed the challenges with maintaining provider data accuracy among payers and hospital systems. She has witnessed nearly every healthcare data issue possible throughout her career and maintains strong connections to every aspect of the healthcare industry. These connections help her stay current with new regulations, new...

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